Point-of-Care Echocardiography Unveils Misclassification of Acute Kidney Injury as Hepatorenal Syndrome
| Autor: | Juan Carlos Q. Velez, Nithin Karakala, Bradley Petkovich, J. Terrill Huggins |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Liver Cirrhosis Male medicine.medical_specialty Delayed Diagnosis Hepatorenal Syndrome Cirrhosis Point-of-Care Systems 030232 urology & nephrology Renal function Pilot Projects Vena Cava Inferior 030204 cardiovascular system & hematology Kidney Function Tests Inferior vena cava End Stage Liver Disease 03 medical and health sciences 0302 clinical medicine Hepatorenal syndrome Internal medicine Ascites medicine Intravascular volume status Paracentesis Humans Prospective Studies Diagnostic Errors Aged medicine.diagnostic_test business.industry Hemodynamics Acute kidney injury Acute Kidney Injury Middle Aged medicine.disease medicine.vein Echocardiography Nephrology Hypertension Cardiology Female medicine.symptom business |
| Zdroj: | American Journal of Nephrology. 50:204-211 |
| ISSN: | 1421-9670 0250-8095 |
| Popis: | Introduction: Fulfillment of the diagnostic criteria for hepatorenal syndrome type 1 (HRS-1) requires prior failure of 2 days of intravenous volume expansion and/or diuretic withdrawal. However, no parameter of volume status is used to guide the need for volume expansion in patients with suspected HRS-1. We hypothesized that point-of-care echocardiography (POCE) may better characterize the volume status in patients with acute kidney injury (AKI) and cirrhosis to ascertain or disprove the diagnosis of HRS-1. Methods: A pilot observational study was conducted to determine the clinical utility of POCE-based examination of inferior vena cava diameter (IVCD) and collapsibility index (IVCCI) to assess intravascular volume status in patients with cirrhosis and AKI who had been deemed adequately volume-repleted and thereby assigned a clinical diagnosis of HRS-1. Early improvement in kidney function was defined as ≥20% decrease in serum creatinine (sCr) at 48–72 h. Results: A total of 53 patients were included. The mean sCr at the time of volume assessment was 3.2 ± 1.5 mg/dL, and the mean Model for End-Stage Liver Disease score was 29 ± 8. Fifteen (23%) patients had an IVCD 40% and were reclassified as fluid-depleted, 11 (21%) had an IVCD >2 cm and IVCCI Conclusion: POCE-based assessment of volume status in cirrhotic individuals with AKI reveals marked heterogeneity. Unguided volume expansion in these patients may lead to premature or delayed diagnosis of HRS-1. |
| Databáze: | OpenAIRE |
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